Inside the 14-year legal battle over Arizona’s broken prison health care system — and the people it failed

Greg Parr was sentenced to10 years in
prison for possession of child pornography in 2016. He was a talented
artist, and he told his wife he was using the images for drawings he
planned.

As flimsy as that excuse was, and as
revolting as the images may have been, he was not sentenced to death or
to life in prison — though that’s essentially what his sentence became.

Parr died in June 2024, nine months
before his sentence was to expire. A liver transplant might have saved
his life, but his wife, Cathy, was told that because of his status in
the Arizona Department of Corrections Rehabilitation and Reentry, he was
not eligible. She was not allowed to visit him, she said. Two days
before he died, she was granted a 15-minute phone call.

“They’re giving me up to die,” he told her.

Then she got the call from a prison chaplain.

“We regret to inform you that your husband, Inmate Greg Parr, has passed away,” he told her.

Her thought at the time: “Twenty-two
years together, and my husband has a new first name: ‘Inmate.’ They
couldn’t even let it go after he died.”

Prison health care has been on trial
in Arizona since 2012, as the state has struggled to see to and pay for
the constitutional rights of its least sympathetic population.

In February, U.S. District Court Judge Roslyn Silver released a 128-page ruling excoriating ADCRR for its long history of negligent health care and seizing control of the system, the latest court order in a 14-year legal saga. 

At issue, as always, was a shortage
of personnel and money and a lack of qualified physicians to take care
of the prisoners, which forces nurses to pick up the slack.

“The nurses are being asked to do
things far outside of their training and their skills,” said Corene
Kendrick, an attorney with the American Civil Liberties Union, which
brought the lawsuit 14 years ago. “They are doing the work of three or
four other people outside the scope of their practice, so, obviously,
mistakes are going to happen and people are going to fall through the
cracks.”

Under Arizona law, prison health care
is contracted out to for-profit companies who can’t afford to pay
competitive salaries and still stay in business.

“If they don’t fill positions, that’s profit,” Kendrick said.

The situation is even more dire if
the inmates need to see a specialist. Few of those physicians are
willing to travel to the middle-of-nowhere prison locations, especially
for the money.

An aging prison population threatens
to turn prisons into nursing homes. And as for mental health care, which
is understandably crucial in a prison setting — perhaps the reason many
of the prisoners are there — according to Silver’s ruling, check-ins
sometimes consist of a counselor stopping outside the cell door and
asking “Are you OK?” Inmates call those visits “drive-bys. Or, Kendrick
says, it consists of giving inmates journals and coloring books, which
might be comforting for the merely anxious, but won’t help the psychotic
who thinks the walls are talking to him.

So, Silver took control of the prison
health care system away from Corrections Director Ryan Thornell and
placed it in receivership, meaning that an outside manager who reports
to the court will run the health care system, regardless of state laws
to the contrary.

Parr’s case was not mentioned in the ruling; ADCRR did not confirm or deny his wife’s account. 

But Silver wrote in detail about
eight other seemingly unnecessary deaths, some of them elderly prisoners
whose medications or chronic diseases were ignored, some mentally ill
prisoners who died by suicide, and prisoners with treatable infections,
undetected cancers and ulcers and bowel perforations. She detailed
another 19 non-fatal instances of negligence or incompetence in medical
care for prisoners.

“You can’t lock somebody up and
starve them,” Kendrick said. “You can’t lock somebody up and refuse to
provide them basic medical care. For better or for worse, the only group
of people in the United States who have a constitutional right to basic
health care are incarcerated people.”

Silver, who has presided over the case since 2018, did not mince words.

“Plainly, only the imposition of the
extraordinary can bring an end to this litigation and the reasons it was
brought,” she wrote. “An end to unconstitutional preventable deaths. An
end to unconstitutional failures to treat those in severe pain. The
Motion for a Receiver will be granted.”

It had been a long time coming.

The case, a class action originally
called Parsons v. Ryan, was filed in 2012 by the Arizona Center for
Disability Law on behalf of 13 inmates of Arizona prisons. It was joined
by the ACLU and the Berkeley, California-based Prison Law Office. It
reached a $44.9 million settlement with then-Corrections Director
Charles Ryan in 2014. But keeping the Corrections Department — and Ryan —
on track was contentious.

U.S. Magistrate Judge David Duncan
found Ryan in contempt of court in 2017 and imposed a sanction of $1.4
million; Ryan appealed and tried to get Duncan removed from the case.
Duncan became so outraged with Ryan that he let go a stinging 10-minute
rebuke in open court.

“I worry it sends a message that we only follow the laws we like,” he said.

Duncan had to warn the Department of
Corrections not to retaliate against prisoners who spoke out about the
lack of medical treatment. In 2018, Duncan took testimony from a
physician who resigned from her job at the prisons when superiors told
her to cancel consults with specialists and to let a heart-attack victim
die if he presented with new heart symptoms. She also said that staff
held meetings on how to “beat the monitors,” court-appointed overseers
of the health care provider.

“Here we are in 2018, and the
failures to meet the stipulations continue, the excuses sound the same,”
he said in open court. “I don’t think anyone contemplated at the time
of the settlement that the system would be so broken. The frustration I
have felt in this case must be so small compared with the suffering of
these people on the prison yards.”

Duncan retired that year, and the case passed to Silver, who had no better luck.

In November 2018, she wrote, “While
defendants are free to utilize the state’s resources as they wish, at
some point, their continued insistence that taxpayer money is better
spent on assiduously defending their non-compliance with the
stipulation, than on remedying the fundamental underlying cause of that
noncompliance, is likely ill-conceived and ill-advised.”

Ryan resigned in 2019. But the case
did not do better under the next director of Corrections, David Shinn,
or the next company contracted to do the work. In 2022, Silver ordered
the case to trial, and in a subsequent 200-page ruling, she threatened
an injunction. The injunction went into effect in April 2023, with the
current Corrections director, Ryan Thornell in office, and a new health
care provider, NaphCare, on board.

To his credit, Thornell made improvements.

In a statement issued after the recent ruling, ADCRR said: “Over
the past three years, ADCRR has made significant, measurable
improvements in health care delivery and infrastructure across Arizona’s
prison complexes. We now have approximately 1,340 full-time equivalent
health care staff, compared to 841 at the time of the Court’s 2022
order. This has included additional doctors, nurse practitioners,
physicians’ assistants, mental health staff, and other health care
staff. In total, the state has invested $1.3 billion in health care
services for prison health care over the past 3 years.”

It was not good enough for
Silver.  As she noted in her February ruling, Arizona had paid $4.2
million to court-appointed monitors, $3.2 million in attorney fees and
sanctions, and more than $300 million a year to NaphCare.

After 14 years, five providers
(including the state), four judges, three directors of corrections, two
contempt citations and one injunction, Silver came to a conclusion.

“The Court has exercised restraint
for much of this litigation, to the point that anymore (sic) tolerance
of unconstitutional health care becomes judicial indulgence,” Silver
wrote.

She had tried less drastic measures,
she said, but “Defendants have consistently dragged their feet, delayed,
exploited ambiguity, and fought compliance at every turn, making
continued insistence on compliance ineffective.”

They lacked leadership, she wrote,
needed to be micromanaged, wasted resources and refused to change their
tactics. Receivership was the best remaining option.

“The Court finds no lesser measure
will suffice to remedy the pervasive constitutional violations present
in Defendants’ health care delivery system,” Silver concluded.

Then the judge ordered that within 60
days, the attorneys and the monitors recommend up to five candidates
for the receiver position and draw up a description of the receiver’s
duties within 30 days.

Receiverships are often used in
bankruptcies and, historically, in federal civil rights cases to manage
school districts. The health care of the California prison system was
placed in receivership in 2005, and though most of those prisons have
been returned to the management of the state, a few remain under court
supervision.

The person appointed could be an
attorney, a hospital administrator, a doctor, preferably someone
experienced in running a health care organization.

What does a receiver do? 

“They actually stand in the shoes of the director for health care,” said Don Specter, one of the attorneys for the prisoners.

Specter and his firm, Prison Law Office, were involved in the California case.

“In California, the medical system
has been transformed,” he said. “People were dying at a horrible rate
because of malpractice and neglect.”

And the receiver would be able to
supercede legislative budget allocations and the laws hampering
progress, notably the state’s insistence that health care be
administered by for-profit corporations.

“Our position will be that the
department should end the contract,” he said. “We hope the state will
join us in waiving that law.”

But ADCRR has vowed to appeal to the 9th Circuit.

NaphCare, in its emailed response to the Mirror, said that its “priority remains on the health and well-being of our patients. 

“After only three years of managing
the health care in Arizona’s prisons, NaphCare has implemented changes
that the governor’s office describes as ‘significant progress,’ and the
Department of Corrections calls ‘measurable improvements.’ This includes
increasing health care staffing levels from around 860 employees to
over 1,300 employees,” the company continued. “Amid this recent
decision, we will continue to focus on our mission to improve and save
lives in the Arizona prison system and look forward to continuing our
work and partnership toward achieving that goal.”  

Gov. Katie Hobbs expressed her deep disappointment in the receivership order since she had “inherited a prison system plagued by a decade of neglect and mismanagement, and had worked with Thornell in good faith to improve conditions.

But those official statements belie what happens day-to-day to the humanity on the ground.

The nurses doing the bulk of the work
might as well be caught in a riptide, unable to meet demand and well
aware of patients’ needs. One former prison nurse reported that she
would call attention to those needing care, but “nothing ever came of
it.” 

Donna Hamm, of the prison advocacy
group Middle Ground Prison Reform, receives complaints every day from
the relatives of prisoners asking on behalf of the nephew who broke his
hand during a work assignment and without medical care is healing in way
that is crippling; the relative with a serious hernia that needs
surgery and keeps popping out of the belt when he does his prison job;
the woman with a painful bowel obstruction and black stool, which
indicates blood; a botched surgery without follow up; the death row
prisoner with a broken shoulder.

“Even the worst guy on death row still has a constitutionally given right to medical care,” Hamm said.

She forwards the complaints to the
lawsuit attorneys, to NaphCare, to Thornell and other ADCRR personnel.
Occasionally she hears back, but usually from the relatives saying that
the prisoner was taken care of.

Greg Parr was not on death row when he died, nor was he the “worst guy.”

His artwork is distinctive.
Super-realist still-life renditions of ordinary objects— one depicts a
Coca-Cola glass on a diner counter next to an old-fashioned juke box.
Horizontal scenes packed with individual faces — he usually drew his own
face among the crowd. Colorful nostalgic dreams with vintage cars and
bygone American archetypes. Portraits of Jesus.

Like most artists, he had a day job, specifically as a substitute art teacher at a public school in Phoenix. 

According to court records, in 2015,
school employees found a thumb drive on the floor at Cortez High School
and plugged it in to figure out who it belonged to. On the drive they
saw a photo of a naked preteen girl near a man’s penis. There were
numerous drawings, presumably Parr’s, depicting sex, and Parr’s name was
on some of the files. He was arrested and pleaded guilty to sexual
exploitation of a minor, which means possession of child pornography.

His court-ordered presentence report
found him to be at low risk to reoffend and noted his positive relations
with his wife and family. But because of the seriousness of the
offense, he was sentenced to 10 years in prison.

His wife loved him anyway.

He continued making art while in prison. But his health deteriorated. He had a heart attack and nearly died. 

“They told me he died three times on
the way to the hospital,” Cathy Parr said, but she only learned that
three days after it happened.

And because he had been a heavy
drinker, he had cirrhosis of the liver and esophageal varices, which are
swollen veins at risk of bursting because of blood backing up from a
cirrhosis-hardened liver. He bounced between private prisons and
hospitals and the ADCRR units in Florence and Buckeye as he was dying of
liver failure. There were nine months left on his sentence.

His medical caseworkers were trying
to get him on a list for a liver transplant, but Cathy Parr was told the
Corrections Department would not approve doing so. Nor was she allowed
to visit.

Finally, she spoke to him on the phone. He told her he was going to die.

“A 15-minute phone call to finish up 22 years of marriage,” she told the Mirror.